Pulmonary, Critical Care and Sleep Medicine Division, Tufts Medical Center, Boston, MA, USA.
Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA; The Institute for Clinical Research and Health Policy Study, Tufts Medical Center, Boston, MA, USA.
J Crit Care. 2018 Dec;48:418-425. doi: 10.1016/j.jcrc.2018.10.004. Epub 2018 Oct 5.
To assess the role of high-flow nasal therapy (HFNT) compared to standard oxygen (SO) as complementary therapy to non-invasive ventilation (NIV).
Multicenter trial including patients (n = 54) anticipated to receive NIV for ≥24 h due to acute or acute-on-chronic respiratory failure. Subjects were randomized (1:1) to SO or HFNT during breaks off NIV. Primary outcome was total time on and off NIV. Secondary outcomes were comfort and dyspnea, respiratory rate (RR), oxygen saturation (SO), tolerance and side effects.
Total time per patient on NIV (1315 vs 1441 min) and breaks (1362 vs 1196 min), and mean duration of each break (520 vs 370 min) were similar in the HFNT and SO arms (p > .05). Comfort score was higher on HFNT than on SO (8.3 ± 2.7 vs 6.9 ± 2.3, p = .001). Dyspnea, RR and SO were similar in the two arms, but the increase in RR and dyspnea seen with SO during breaks did not occur with HFNT.
Compared to SO, HFNT did not reduce time on NIV. However, it was more comfortable and the increase in RR and dyspnea seen with SO did not occur with HFNT. Therefore, HFNT could be a suitable alternative to SO during breaks off NIV.
评估高流量鼻导管氧疗（HFNT）与标准氧疗（SO）作为补充治疗非侵入性通气（NIV）的作用。
这是一项多中心试验，纳入了预计需要接受 NIV 治疗≥24 小时的患者（n=54），这些患者因急性或急性加重期慢性呼吸衰竭而接受治疗。患者被随机分为 SO 组或 HFNT 组，在 NIV 暂停期间接受相应治疗。主要结局为总 NIV 使用时间和脱机时间。次要结局为舒适度和呼吸困难、呼吸频率（RR）、氧饱和度（SO）、耐受性和不良反应。
HFNT 组和 SO 组患者的 NIV 总使用时间（1315 分钟比 1441 分钟）和 NIV 暂停时间（1362 分钟比 1196 分钟）相似，且每次 NIV 暂停的平均持续时间（520 分钟比 370 分钟）也相似（p＞.05）。HFNT 组的舒适度评分高于 SO 组（8.3±2.7 比 6.9±2.3，p=0.001）。HFNT 组和 SO 组的 RR 和 SO 相似，但在 SO 组，NIV 暂停期间 RR 和呼吸困难增加，而 HFNT 组并未发生这种情况。
与 SO 相比，HFNT 并未减少 NIV 使用时间。然而，HFNT 更舒适，并且在 NIV 暂停期间，SO 引起的 RR 和呼吸困难增加的情况并未在 HFNT 组发生。因此，HFNT 可能是 NIV 暂停期间替代 SO 的一种合适选择。
